Clinical Decisionmaking

Massage may be an effective alternative to conventional medical care for persistent back pain

Back pain is one of the most common reasons that Americans use complementary and alternative medical (CAM) therapies. For example, in 1997, one-third of U.S. adults with low back pain visited a CAM provider—usually chiropractors, massage therapists, and acupuncturists—for their problem. According to a recent study supported in part by the Agency for Healthcare Research and Quality (HS09351), massage effectively relieved persistent back pain and/or disability, but Traditional Chinese Medical (TCM) acupuncture by licensed acupuncturists was relatively ineffective.

Researchers led by Daniel C. Cherkin, Ph.D., of the Group Health Cooperative, Seattle, WA, randomized 262 patients (aged 20 to 70 years) with persistent back pain to receive acupuncture (94 patients), therapeutic massage (excluding acupressure and shiatsu that may have effects similar to acupuncture) that focused on manipulation of soft tissues (78), or self-care educational materials that included recommended exercises (90). Patients were allowed up to 10 massage or acupuncture visits over 10 weeks. The researchers assessed symptoms (0-10 scale, with 10 being most severe symptoms) and dysfunction (0-23 scale, with 23 being greatest dysfunction) by telephone interviews initially and 4, 10, and 52 weeks later.

After 10 weeks, massage patients had less severe symptoms than self-care patients (3.41 vs. 4.71) and less dysfunction than self-care (5.88 vs. 8.92) and acupuncture (5.89 vs. 8.25) patients. Only 5 percent of patients in the massage group compared with 19 percent in the acupuncture and self-care groups reported more than a week of restricted activity. After 1 year, massage was no better than self-care, but it was better than acupuncture at decreasing symptoms (3.08 vs. 4.74) and dysfunction (6.29 vs. 8.21). However, because many acupuncturists felt constrained by protocols that prohibited them from using herbs and Chinese massage, it is unclear whether a less constrained approach would have been more effective. It also is unclear which aspect of massage therapy makes it effective.

See "Randomized trial comparing Traditional Chinese Medical acupuncture, therapeutic massage, and self-care education for chronic low back pain," by Dr. Cherkin, David Eisenberg, M.D., Karen J. Sherman, Ph.D., and others, in the April 2001 Archives of Internal Medicine 161, pp. 1081-1088.

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